Evaluation of Laparoscopic Combined Sleeve Gastrectomy and Mini-Gastric Bypass in Treatment of Morbid Obesity

Abstract
Background: Combined sleeve gastrectomy and MGB is a modified bariatric procedure composed of the standard procedures of sleeve gastrectomy and MGB that can be performed by laparoscopic technique. This combined procedure is still a novel technique with assumed beneficial effects based on the theory and former experiences with both techniques individually.
Aim of Study: Assessment of the efficacy of combined sleeve gastrectomy and MGB in treatment of morbidly obese patient as regard weight reduction and control of co-morbidities.
Patient and Methods: From January 2016 to January 2018, laparoscopic combined sleeve gastrectomy and MGB was performed in 20 patients at the Gastrointestinal Surgery Unit, General Surgery Department, Tanta University, Egypt.
Results: The study population included 18 females and 2 males with a mean age of 33.13±7 years. The mean pre-operative Body Mass Index (BMI) was 54. 13±60kg/m2. All procedures were completed laparoscopically. Comorbidities: The mean operative time was 153±27.7 minutes and the mean postoperative hospital stay was 6.1±5.8 days. Early compli-cations were encountered in 4 cases (20%) including 3 port site infections (15%), stable line leakage 5 days after operation was recorded in 1 case (5%). Late complications included 6 cases (30%). Pre-operative obesity related co morbidities; hypertension in 2 cases, diabetes mellitus in 3 cases, Dyslip-idaemia in 4 cases and arthrealgia in 7 cases. The mean BMI 18 months after surgery was 29.23±3.4kg/m2, and the EWL% ranged between 51.45% and 98.2% with a mean of 80.68±10.55 18 months after operation. Most of the co-morbidities improved or resolved; 100% for hypertension and diabetes mellitus, 75% for dyslipidemia and 71.4% for artheralgia.
Conclusion: Despite the short duration of follow-up for most of the patients, combined SG and MGB can be considered an effective surgical procedure for treatment of morbid obesity in terms of weight reduction and control of co-morbidities. A higher cost is expected for this procedure due to the larger number of cartridges used. Like other bariatric procedures, this novel procedure was attended with post-operative complications mainly staple line leakage, biliary reflux, stomal ulcer, nutritional deficiencies and symptomatic gallbladder stones.